| NPI | 1275614612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 414164) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: SC 25044) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011291) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2016-08-23 |